Irritable bowel syndrome (IBS) presents itself as a variety of lower abdominal symptoms, including pain, cramping, gassiness, and either or both diarrhea and constipation. Symptoms often appear after eating or during stress and result from abnormal motility. Because the gastrointestinal tract is particularly sensitive to stimuli, the effect of stress, diet, drugs, hormones, and minor irritants can aggravate its tendency to contract abnormally.

The syndrome generally takes two forms. Spastic colon, often triggered by eating a meal, produces periods of constipation, diarrhea, or both, along with abdominal pain. Painless diarrhea comes on urgently, generally during or after a meal, or on waking after a night's sleep.

IBS often starts in young adulthood. Between 10% and 20% of the population has symptoms of the syndrome at some time. It accounts for half of all gastrointestinal referrals, and is a major cause of lost work or school time. It affects twice as many women as men. Some women show more symptoms during menstruation.

No underlying anatomic or definitive etiologic cause has emerged. The symptoms result from abnormal motility, and the contractions become disorganized, harsh, or spasmodic. The erratic propulsion that results can cause sudden, explosive elimination of stools, or can delay any elimination. Chronic stress or depression often trigger attacks. Eating in general can cause immediate need for a bowel movement. Specific foods such as high-fat meals, wheat, dairy products, and citrus fruits, as well as drinks containing caffeine or alcohol, can aggravate the condition.

• Stress
• Depression
• In some cases, eating specific foods, including wheat, dairy products, or citrus fruits
• In some cases, alcohol or caffeine
• Familial predisposition

• Crampy pain in the lower abdomen
• Bloating
• Gassiness
• Changes in bowel habits
• Diarrhea or constipation, or both alternately
• Need for bowel movement immediately on waking or after eating
• Relief of pain after bowel movement
• Feeling of incomplete emptying after bowel movement
• Mucus in feces

• Inflammatory bowel diseases (ulcerative colitis or Crohn's disease)
• Diverticulosis
• Duodenal ulcer
• Lactose intolerance
• Biliary tract disease
• Abuse of cathartics
• Amebiasis, giardiasis, or other parasitic disease
• Campylobacter enteritis
• Allergic gastroenteropathy
• Colonic polyps
• Colonic neoplasms
• Ischemic enteropathy (in patients over age 60)
• Ovarian neoplasms and cysts
• Uterine fibroids
• Hyperthyroidism
• Infections
• Diabetes mellitus

Patients with either form of IBS usually appear in good health. Palpation of the abdomen may show tenderness. Rectal examination often indicates a rectum that is empty or contains hard, firm feces. A pelvic examination of women serves to eliminate alternative diagnoses.

• A stool sample—preferably a three-day slide series—can reveal the presence of blood, ova, parasites or bacteria.
• Biochemical profiling, including serum amylase, and urinalysis, also serves to narrow the diagnosis—ESR, CBC.

Abdominal ultrasound, a barium enema X ray, X rays of the small bowel or the upper gastrointestinal tract, and colonoscopy can also help to rule out organic causes of IBS-like symptoms.

Sigmoidoscopy, particularly with a flexible instrument, shows the state of the colon up to 60 centimeters, the area in which 65% to 70% of colonic neoplasms and polyps are found. In cases of IBS, this procedure often triggers spasm and pain, but shows no abnormalities.

Sympathetic understanding plays a major role in treatment. Explain the nature of the condition, and assure the patient that he or she has no major underlying organic disease. Outline the extreme sensitivity of the patient's bowels to stimuli such as stress, food, drugs, and hormones. Remember that no two IBS patients are alike. Encourage patients to avoid, wherever possible, stressful situations that may trigger episodes of IBS.

• Oral doses of antispasmodic agents such as hyoscyamine (Anaspaz, Cytospaz, Levsin) or dicyclomine (Bentyl, Bemote, Di-Spaz) can reduce the pain of spasm. They should be taken 30 to 60 minutes before meals. Oral doses of amitriptyline, taken 30 to 60 minutes before meals, reduce depression and bowel spasms.
• Bulk-producing agents (psyllium, as in Metamucil) or antiflatulents (simethicone, as in Mylicon) as symptoms indicate
• Lactose capsules for lactose intolerance, as indicated
• Patients with diarrhea should take loperamide (as in Imodium) before meals, as needed.

Irritable bowel syndrome is a multifactoral condition that can often be successfully treated with alternative therapies. Most important are proper eating habits, stress reduction, and gastrointestinal support. Incorporating nutritional supplements may help reduce the effects of stress. Intestinal support can include fiber, acidophilus, peppermint oil capsules, or a tea of fennel or ginger. Chronic IBS may also respond to digestive enzymes and a supportive tincture. Stress reduction techniques through biofeedback, hypnosis, or counseling can help patients to deal with stress.

• Removal of known food allergens or food irritants is imperative. The most common food allergens are dairy, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. An elimination/challenge trial may be helpful in uncovering sensitivities. Remove all suspected allergens from the diet for two weeks. Add in one food every three days and wait for reaction which may include digestive upset, headache, fatigue, flushing, or worsening of symptoms.
• Fiber supplementation helps reduce abdominal pain, cramping, and gas. Supplements include psyllium, flaxmeal, slippery elm (Ulmus fulva) powder, marshmallow root (Althaea officinalis) powder.
• Digestive enzymes taken 20 minutes before meals can help enhance digestion and normalize bowel function.
• One teaspoon of raw bran with each meal, supplemented by extra fluids, provides fiber reliably.
• Pro-flora supplements such as acidophilus and lactobacillus species taken bid to tid can help to rebalance normal bowel flora and reduce gas and bloating.
• Magnesium (200 mg bid to tid) and B-complex (50 to 100 mg/day) with extra B5 (pantothenic acid; 100 mg/day) may help to reduce the effects of stress.
• Low-fat diets may relieve abdominal pain following meals. Patients with spasm and constipation often benefit from dietary fiber supplementation.

Ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

• Enteric-coated peppermint oil (Mentha piperita): one to two capsules (0.2 ml peppermint oil/capsule) tid after meals. Peppermint oil is a potent spasmolytic that reduces bowel irritability.
• A tea of fennel seed (Foeniculum vulgare) or ginger root (Zingiber officinale) taken after meals promotes elimination of intestinal gas and good digestion.
• A tincture of equal parts of the following herbs may be taken before meals (30 drops tid): valerian (Valeriana officinalis), passionflower (Passiflora incarnata), anise seed (Pimpinella anisum) extract, meadowsweet (Filipendula ulmaria), wild yam (Dioscorea villosa), and milk thistle (Silybum marianum). Combined, they enhance digestion, relieve spasm, and reduce inflammation.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency.

• Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
• Regular exercise, such as walking, can reduce stress, and encourages bowel movements in constipated individuals.
• Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory. Apply oil directly to skin, cover with a clean soft cloth (e.g., flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days.
• Abdominal breathing helps to induce the relaxation response and may aid normal physiological functioning (e.g., digestion). Chewing food thoroughly enhances digestion. Enzyme release begins in the mouth.

Acupuncture can be useful in reducing frequency and duration of IBS episodes as well as providing overall support to gastrointestinal function.

Therapeutic massage may be beneficial in reducing the effects of stress and increasing the overall sense of well-being.

Insist on regular follow-up visits, to ensure that symptoms remain under control, and to detect any possible organic diseases of the gastrointestinal tract. Make patients aware that they may suffer episodes of abdominal symptoms related to psychologic stress and depression.

Best to develop pattern of regular exercise, to reduce stress and aid GI motility. A diet generally higher in fiber and lower in fat.

Depression or anxiety associated with unresolved symptoms

Recurrences throughout life, particularly at times of high stress or relaxed preventative measures

Pregnancy may exacerbate symptoms of IBS. Treatment must be supervised by an experienced practitioner.

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